氯氮平引起粒细胞缺乏的危险因素

粒细胞缺乏(ａｇｒａｎｕｌｏｃｙｔｏｓｉｓ)是氯氮平的一个极其严重的副作用,不少国家都制定了严格的因粒细胞减少或缺乏而停用氯氮平以及对已减少的白细胞或粒细胞制定了监查标准[1,2]。从现象学上来看,白细胞减少症(ｌｅｕｋｏｐｅｎｉａ)是粒细胞缺乏的发展早期,但两者却有很多不同,虽然这种差异存在有其客观性,不过成功地预防了白细胞减少症,便可成功地预防粒细胞缺乏症。显然,白细胞减少的危险因素也同样与粒细胞缺乏有关。1　与药物有关的危险因素在与药物相关的研究中,剂量或总量与其所致关系不甚明显,而且与氯氮平药物的血液浓度…     

氯氮平所致粒细胞缺乏症30例临床分析

目的观察氯氮平所致粒细胞缺乏症。方法 样本选自１９７８年至１９９７年１０月住院单用或合并使用氯氮平所致的粒细胞缺乏症者。结果 氯氮平引起粒细胞缺乏症３０例，结论 氯氮平所致粒细胞缺乏症较少见，本文发生率为１．６‰。用药之初３个月，应密切观察白细胞计数及病人可能出现的感染症状，及时处理，绝大多数病人能化险为夷。     

氯氮平所致粒细胞缺乏

对氯氮平致白细胞减少及粒细肥缺乏的病例进行分析。     

氯氮平引起粒细胞减少或缺乏的预测

我们在临床护理工作中发现,氯氮平引起粒细胞缺乏前有体温轻度升高现象,这可否作为粒细胞缺乏的监测,值得探讨。     

氯氮平引起粒细胞缺乏致死3例回顾分析

氯氮平作为非典型抗精神病药物的代表，属二苯氧氮平类，其药理作用是对中脑边缘系统多巴胺受体通道起阻滞作用。自1966年问世以来，国内外均因有报道引起粒细胞减少或缺乏的可能而限制使用。国内也有很多关于氯氮平副反应的报道，但多数观点认为氯氮平对骨髓抑制的现象很少发生，因而还是安全的。     

氯氮平与粒细胞缺乏

本文报告我院(416例)和其它83所精神病院(86458例)用国产氯氮平治疗精神病的粒细胞缺乏发生率分别为7.2‰和0.88‰。死于粒缺分别为1例和13例,死亡率2.4‰和0.15‰。结果提示氯氮平疗效虽好,但副作用严重,值得重视。     

氯氮平诱发的粒细胞缺乏症——机理探讨

本介绍了氯氮平诱发的粒细胞缺乏症的特点，以及在免疫学，细胞毒理学和遗传学方面发生机理的探讨。     

氯氮平联合碳酸锂治疗引起粒细胞缺乏1例

1病例情况患者,女性,20岁,未婚,待业。因兴奋话多,活动多2个月,于2009年5月29日入院治疗。既往体健,无重大躯体疾病史,家族史阴性。病前性格内向,无烟酒不良嗜好。入院体格检查未见异常。     

人类白细胞抗原和氯氮平诱发的粒细胞缺乏症

目的探讨氯氮平诱发的粒细胞缺乏症（简称为粒缺）与人类白细胞抗原（ＨＬＡ）的相关关系。方法对２９例精神分裂症患者进行了ＨＬＡ分型研究。结果２９例中７例发生粒缺患者的ＨＬＡ－ＤＲ１２（５）抗原频率显著高于２２例粒缺未发生的患者，Ｐ＜０．０１。在精神分裂症患者与健康对照组之间，未发现该抗原频率差异有显著性。结论提示服用氯氮平发生粒缺的患者可能有特异的遗传素质，遗传基础与ＨＬＡ－ＤＲ１２（５）基因有关，相对危险性（ＲＲ）＝３８．１５６，而与疾病自身因素无关。     

氯氮平致粒细胞缺乏症危险因素的对照研究

目的 探讨氯氮平治疗引起的粒细胞缺乏症的危险因素,方法 采用１：２病例对照方法和计算Ｘ＾２ＯＲ值,分析了１３例氯氮平致粒细胞缺乏症患者及其对照组中暴露因子的差异,结果 两组在病毒性肝炎病史（Ｐ〈０．０２５）早期感冒或类感冒现象（Ｐ〈０．０１）,影响造血系统药物应用史（Ｐ〈０．００５）,三因素之间有明显差异,而合并用药,免疫病史,ＥＥＧ异常,化学毒物或放射线接触史之间则无明显差异,结论 病毒性肝炎史     

Add-on filgrastim during clozapine rechallenge unsuccessful in preventing agranulocytosis

Granulocyte colony-stimulating factor agents such as filgrastim can be administered in order to reduce the duration of clozapine-induced agranulocytosis. Successful long-term combination treatment with filgrastim and clozapine in patients with previous clozapine-induced agranulocytosis has been described in several cases. We describe a patient with schizophrenia who developed agranulocytosis during treatment with clozapine and who did not respond to other antipsychotics. Add-on treatment with filgrastim during a clozapine rechallenge did not prevent the reoccurrence of agranulocytosis, and clozapine treatment had to be discontinued. Our case suggests that add-on filgrastim is a therapeutic option when clozapine is rechallenged, but physicians should be aware of the potential dangers especially severe clozapine-induced agranulocytosis.     

Leukopenia in clozapine treated patients may be induced by other drugs: a case series

The combination of clozapine and other potentially leukopenic drugs may pose a greater risk for neutropenia. However, neutropenia may not always be due to clozapine. When adding potentially leukopenic drugs, clinicians should look for possible alternatives especially as clozapine is often a drug used as the last resort in treatment refractory schizophrenia.     

Circadian rhythm of neutrophil counts and granulocyte macrophage-colony stimulating factor (GM-CSF) under clozapine treatment: A case report

Agranulocytosis is a severe side effect of clozapine which requires stopping this medication immediately in the case of progressive neutropenia. There are, however, cases of benign neutropenia under clozapine that do not progress. The ability to predict progression vs. non-progression in neutropenia cases under clozapine would be highly valuable for avoiding unnecessary treatment withdrawals. In this context, we closely monitored circadian neutrophil counts and granulocyte macrophage-colony stimulating factor (GM-CSF) levels in a patient who had low normal neutrophil counts at baseline and developed neutropenia under clozapine treatment. Methods. Venous blood samples were drawn in close intervals for 4 weeks. At several time points blood was sampled in the morning between 08:30 and 9:30 h and a second time in the afternoon between 14:00 and 15:00 h. Results. The circadian rhythm of neutrophil counts and GM-CSF levels was unchanged. There was no progression to agranulocytosis, and clozapine could be continued. Conclusions. In view of the available literature and the presented case it is suggested that further studying of circadian profiles of neutrophil counts, neutrophil regulatory factors, such as GM-CSF, and their intercorrelation may help to find a biomarker of benign vs. malign neutropenia under clozapine.     

Clinical profile of clozapine: Adverse reactions and agranulocytosis

The arrival of clozapine has been one of the most significant developments in antipsychotic drug treatment since the advent of chlorpromazine ushered in the psychopharmacologic era. However, its utilization has been significantly limited and complicated by its potential to cause adverse effects and agranulocytosis in particular. It must be emphasized that clozapine has a side effect profile that is in many ways distinct from standard typical antipsychotic drugs. Side effects with clozapine are common and range from the benign to the potentially lethal. The most common side effects include sedation, dizziness, and sialorrhea during sleep; the most serious are agranulocytosis, seizures and respiratory depression. Although side effects from clozapine are not necessarily preventable, they are for the most part manageable. Even with the most serious adverse effects, proper knowledge of the medication's actions, clinical vigilance, and prompt intervention can prevent the occurrence of significant morbidity and mortality as a consequence of clozapine treatment.     

氯氮平所致"类感染综合征"误诊39例分析

目的：调查氯氮平所致“类感染综合征”的误诊发生率及原因。方法：用自制的调查表对1991-1995年期间所有单服氯氯平合并呼吸道院内感染的病例对照“类感染综合征”标准进行重新诊断，并对院内感染组及类感染组进行比较。结果：“类感染综合征”的误诊率为21．31％，类感染组与感染组比较，类感染组氯氮平剂量较低、出现时间较早，且经处理后症状缓解较快。结论：氮氯平所致“类感染综合征”易误诊，临床工作中应高度重视。